Background Verapamil-sensitive, idiopathic left ventricular tachycardia （ILVT） with right bundle branch block configuration and left-axis deviation is known to be due to re-entry mechanism but the exact nature of re...Background Verapamil-sensitive, idiopathic left ventricular tachycardia （ILVT） with right bundle branch block configuration and left-axis deviation is known to be due to re-entry mechanism but the exact nature of reentrant circuit in ILVT is not fully elucidated. Radiofrequency （RF） ablation was applied during ventricular tachycardia （VT） and termination of the VT or abolishing the inducibility of the tachycardia was used as an endpoint for successful RF. In this study, the left posterior fascicular block in surface electrocardiogram （ECG） was used as a new endpoint of ablation to cure ILVT. Methods Electrophysiological studies and radiofrequency ablation were performed in 39 consecutive patients [30 men, 9 women; age ranging from 10 to 64 years, mean （29± 16） years] with verapamil-sensitive ILVT and structurally normal hearts. VT could be terminated by the intravenous adininistration of verapamil in all patients. The target site was the midseptum of LV where the earliest Purkinje potentials were recorded during VT. RF current was applied to the target site with or without late diastolic potential （LDP） during sinus rhythm in 37 patients and during VT in 2 patients to meet the ablation endpoint： the left posterior fascicuiar block in the surface ECG. Results Thirty-seven patients with ILVT had been treated by RF ablation during sinus rhythm and two had been treated during VT. All of them met the endpoint of the left posterior fascicuiar block. Thirty-eight cases were symptom-free without medications during the follow-up period （range from 3 to 95 months, median 17 months）. One patient developed a clinical recurrence and the left posterior fascicuiar block in surface ECG disappeared. The patient received another treatment. The endpoint was met and the procedure was successful. Conclusions The left posterior fascicuiar block in surface ECG used as an endpoint of RF ablation to treat ILVT is effective. It is important especially in those patients whose VT can not be induced or the indu展开更多
目的报道射频导管消融治疗儿童左室特发性分支性室性心动过速(ILFVT)的有效性及安全性。方法本中心2000年6月至2019年4月射频导管消融治疗30例儿童ILFVT,年龄1~14岁,男性12例,女性18例。常规心内电生理检查明确ILFVT诊断后经X线二维或CA...目的报道射频导管消融治疗儿童左室特发性分支性室性心动过速(ILFVT)的有效性及安全性。方法本中心2000年6月至2019年4月射频导管消融治疗30例儿童ILFVT,年龄1~14岁,男性12例,女性18例。常规心内电生理检查明确ILFVT诊断后经X线二维或CARTO三维系统引导标测消融,消融靶点为心动过速时左室间隔部标测最早激动处或窦性心律时左室间隔部最早Purkinje电位或舒张期电位处。结果 29例诊断为左后分支ILFVT,1例诊断为左前分支ILFVT。经X线引导ILFVT标测消融13例,应用CARTO三维系统引导标测消融17例。CARTO三维标测指导下消融的手术时间、X线曝光时间明显短于X线二维指导下消融,分别为[(30±10)min vs (50±20)min,P<0.05;(5±2)min vs (15±5)min,P<0.05]。30例患者ILFVT均消融成功。随访2年,2例应用X线指引消融ILFVT复发,经再次消融成功。无并发症发生。结论射频消融治疗儿童左室特发性室性心动过速安全、有效。展开更多
文摘Background Verapamil-sensitive, idiopathic left ventricular tachycardia （ILVT） with right bundle branch block configuration and left-axis deviation is known to be due to re-entry mechanism but the exact nature of reentrant circuit in ILVT is not fully elucidated. Radiofrequency （RF） ablation was applied during ventricular tachycardia （VT） and termination of the VT or abolishing the inducibility of the tachycardia was used as an endpoint for successful RF. In this study, the left posterior fascicular block in surface electrocardiogram （ECG） was used as a new endpoint of ablation to cure ILVT. Methods Electrophysiological studies and radiofrequency ablation were performed in 39 consecutive patients [30 men, 9 women; age ranging from 10 to 64 years, mean （29± 16） years] with verapamil-sensitive ILVT and structurally normal hearts. VT could be terminated by the intravenous adininistration of verapamil in all patients. The target site was the midseptum of LV where the earliest Purkinje potentials were recorded during VT. RF current was applied to the target site with or without late diastolic potential （LDP） during sinus rhythm in 37 patients and during VT in 2 patients to meet the ablation endpoint： the left posterior fascicuiar block in the surface ECG. Results Thirty-seven patients with ILVT had been treated by RF ablation during sinus rhythm and two had been treated during VT. All of them met the endpoint of the left posterior fascicuiar block. Thirty-eight cases were symptom-free without medications during the follow-up period （range from 3 to 95 months, median 17 months）. One patient developed a clinical recurrence and the left posterior fascicuiar block in surface ECG disappeared. The patient received another treatment. The endpoint was met and the procedure was successful. Conclusions The left posterior fascicuiar block in surface ECG used as an endpoint of RF ablation to treat ILVT is effective. It is important especially in those patients whose VT can not be induced or the indu
文摘目的报道射频导管消融治疗儿童左室特发性分支性室性心动过速(ILFVT)的有效性及安全性。方法本中心2000年6月至2019年4月射频导管消融治疗30例儿童ILFVT,年龄1~14岁,男性12例,女性18例。常规心内电生理检查明确ILFVT诊断后经X线二维或CARTO三维系统引导标测消融,消融靶点为心动过速时左室间隔部标测最早激动处或窦性心律时左室间隔部最早Purkinje电位或舒张期电位处。结果 29例诊断为左后分支ILFVT,1例诊断为左前分支ILFVT。经X线引导ILFVT标测消融13例,应用CARTO三维系统引导标测消融17例。CARTO三维标测指导下消融的手术时间、X线曝光时间明显短于X线二维指导下消融,分别为[(30±10)min vs (50±20)min,P<0.05;(5±2)min vs (15±5)min,P<0.05]。30例患者ILFVT均消融成功。随访2年,2例应用X线指引消融ILFVT复发,经再次消融成功。无并发症发生。结论射频消融治疗儿童左室特发性室性心动过速安全、有效。
